This is a post from the blog of Professor emeritus Dr. Richard Hayes, who taught Buddhism and Sanskrit at McGill University, and is now back home in the 4 corners area of the United States. Dayamati Hayes is also a Quaker, peace activist, vegan, and a conscientious objector from the Viet Nam war. As a friend who I have known on internet lists and now on social media for more than several decades, Dr. Hayes is well known and respected for his wit, wisdom, and insight into our human condition. In fact, there are too many excellent posts one could share from Richard, but this one is only a sample, and one that has some relevance to digital health:
Watching the news makes people sick
At the outset I must confess to being addicted to watching the news on
television. Although my favorite televised news sources are on PBS, on
most nights I supplement the
PBS News Hour with
the news on one of the traditional network stations or a cable news
channel. Something that has repeatedly struck me in watching the evening
news on traditional network stations is that advertisers have obviously
learned that the vast majority of people who watch the evening news are
suffering from indigestion, irritable bowel syndrome, erectile
dysfunction, atrial fibrillation not caused by a heart-valve problem,
moderate to severe psoriasis, rheumatoid arthritis, osteoporosis,
depression, insomnia, restless leg syndrome or dry eye disease. If not
afflicted by one of those conditions, they are being assaulted by
meatballs or chicken wings.
Not all the commercials are pushing drugs, of course. Interspersed with
all the pharmaceutical products are commercials featuring lawyers who
are prepared to sue pharmaceutical companies for offering products that
have life-changing side effects, and health insurance plans that
complement Medicare to provide coverage to pay for all those
pharmaceuticals that TV viewers are urged to ask their doctors about.
Given the evidence of television commercials, remarkably few of the
people who watch the televised news are under the age of sixty-five and
have sound minds in sound bodies.
An often-heard claim of those who are convinced that the Affordable Care
and Patient Protection Act has all but destroyed the health-care system
in the United States is that the ACA (which they persist in calling
Obamacare) has driven insurance premiums through the ceiling, thus
bringing financial ruin to small businesses and confronting hard-working
Americans with having to choose between health insurance and sending
their children to overpriced universities. What is missed in this
analysis, of course, is that health insurance is expensive because
medical care and pharmaceuticals are expensive. Also left out of
consideration is that almost every pharmaceutical product sold in the
United States is available in Canada for a fraction of the cost.
Why don’t Canadians pay their share of the cost of drugs?
A claim I have heard many American make, clearly a claim that they have
learned from the pharmaceutical companies themselves, is that the prices
of pharmaceutical products are so high in the United States because it
costs pharmaceutical companies a great deal of money to do the research
necessary to develop new products. Some American friends have even
showed indignation that Americans are subsidizing Canadians, who derive
all the benefits of expensive medical research but pay none of the cost.
Once, when I was still living in Canada, I received an email from a
(former) friend in the United States who accused me, in language
unsuitable for anyone not in either the navy or a motorcycle gang, of
being a freeloader who was enjoying good health at the expense of poor
Americans. That claim was false for two reasons. First, I have almost
never been prescribed a pharmaceutical product and tend to avoid
over-the-counter medical products. Second, there are better explanations
for why pharmaceutical prices are outrageously high in the United
States. So the answer to the question “Why don’t Canadians pay their
share of the cost of drugs?” is that they in fact do pay their fair
share. Americans pay more, not because they are subsidizing freeloading
Canadians, but because Americans pay far more for products than it costs
to develop and manufacture those products.
Why do Americans pay for overpriced pharmaceuticals?
The pharmaceutical companies typically claim that they must charge high
prices for their products because of the high cost of developing them.
It cannot be denied that running controlled tests on new products and
making sure the products meet safety standards is costly. It should also
be pointed out, however, that advertising the products once they are
developed is also costly. To that can be added that pharmaceutical
companies also tend to pay shareholders rather high dividends. When
health care products are manufactured by for-profit corporations that
have investors to reward with high dividends, then costs naturally rise.
While the claim of many advocates of free-market capitalism is that
competition keeps costs down, the opposite is often the case. If two
companies are competing for a share of the market, the cost of the
competition—the advertising of products to potential consumers of the
products and to potential prescribers of those products—can be quite
high.
Neither of those kinds of advertising is necessary. There is no
justification whatsoever for running expensive advertisements on
television that end with the line “As you doctor whether…is right for
you.” There is no need to make the patient into a sales representative
for a product that the patient may end up buying. If someone has, say,
osteoporosis, then it should be sufficient for the physician to suggest a
range of possible treatments, and to tell the patient the desired
effects and the likely side effects of each of the possible treatments.
And that information should be given directly to the physician in the
form of the results of clinical trials, not in the form of slick
presentations delivered in the context of work-vacations at expensive
resorts. The cost of disseminating objective information is relatively
low, whereas the cost of trying to persuade a physician to prescribe
product A rather than the almost-identical product B is much higher.
One way to bring medical costs down is to make advertising of medical
products illegal, as it is in some countries that have lower costs for
pharmaceuticals and hands-on medical care. Another way is to have
government-imposed limits on the amount of profit a company can make on a
product, as is also the case in some countries that have reasonable
consumer-costs for health-related products. A third way is to have a
government-run insurance plan that negotiates prices with pharmaceutical
companies and imposes a cap on how much a pharmaceutical company can
receive for its products. There is no need for a government-run plan to
be managed by the central government. In Canada each province has its
own plan, and no two provinces have exactly the same setup.
Health care is far too important to be left to the vagaries of markets
in a for-profit corporate scheme. The good health of the entire
citizenry is far more important than the bank accounts of capitalist
shareholders. There are plenty of other markets in which investors can
make or lose their money. Pharmaceutical companies, manufacturers of
medical devices, clinics, hospitals and retirement homes for the elderly
should not be in the private investment sector of the economy. (Neither
should correctional facilities, but that is a matter for another day.)
Americans desiring affordable health insurance should first advocate for
more affordable treatments, and that is best achieved by a
not-for-profit health-care system. They should be asking for, in fact demanding, more
government involvement and less private-sector investment in products
designed for health. Such a change in outlook would, however, require
that Americans first seek a cure for their addiction to free-market
capitalism and the delusion that the best way to keep costs down is to
let the market determine prices. That strategy has been tried again and
again, and it has failed again and again. It is time for Americans to
considered an alternative system (not to be confused with “alternative
facts”).
Next time you see a television commercial for an expensive treatment
that you have seen a hundred times before, instead of simply reaching
for the mute button on the remote control, ask your doctor whether
socialized medicine is right for you. If you doctor says No, then
consider seeking a second opinion.
